2013 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 11 - Unauthorized Insurers -- Prohibitions and Process 11.11-045 Jurisdiction over providers of health care benefits.
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304.11-045 Jurisdiction over providers of health care benefits.
(1)
(2)
(3)
(4)
(5)
(6)
The purpose of this section is to give Kentucky jurisdiction over providers of
health care benefits; to indicate how each provider of health care benefits may
show under what jurisdiction it falls; to allow for examination by Kentucky if the
provider of health care benefits is unable to show it is subject to another
jurisdiction; to make such a provider of health care benefits subject to the laws
of Kentucky if it cannot show that it is subject to another jurisdiction; and to
disclose to purchasers of such health care benefits whether or not the plans
are fully insured.
Notwithstanding any other provision of law, and except as provided herein, any
person or other entity which provides coverage in this state for medical,
surgical, chiropractic, physical therapy, speech pathology, audiology,
professional mental health, dental, hospital, or optometric expenses, whether
such coverage is by direct payment, reimbursement, or otherwise, shall be
presumed to be subject to the jurisdiction of the department, unless the person
or other entity shows that while providing such services it is subject to the
jurisdiction of another agency of this state, any subdivision thereof, or the
federal government.
If a person or entity wishes to show that it is subject to the jurisdiction of
another agency of this state, any subdivision thereof, or the federal
government, such showing shall be made by providing to the commissioner the
appropriate certificate, license, or other document issued by other
governmental agency which permits or qualifies it to provide those services.
Any person or entity which is unable to show under subsection (3) that it is
subject to the jurisdiction of another agency of this state, any subdivision
thereof, or the federal government, shall submit to an examination by the
commissioner to determine the organization and solvency of the person or the
entity, and to determine whether or not such person or entity complies with the
applicable provisions of this chapter.
Any person or entity unable to show that it is subject to the jurisdiction of
another agency of this state, any subdivision thereof, or the federal
government, shall be subject to all appropriate provisions of this code
regarding the conduct of its business.
Any production agency or administrator which advertises, sells, transacts, or
administers the coverage in this state described in subsection (2) of this
section and which is required to submit to an examination by the commissioner
under subsection (4) of this section shall, if said coverage is not fully insured or
otherwise fully covered by an authorized life or health insurer, nonprofit
hospital, medical-surgical, dental, and health service corporation, health
maintenance organization, or prepaid dental plan organization, advise every
purchaser, prospective purchaser, and covered person of such lack of
insurance or other coverage. Any administrator which advertises or administers
the coverage in this state described in subsection (2) of this section which is
required to submit to an examination by the commissioner under subsection (4)
of this section shall advise any production agency of the elements of the
coverage, including the amount of "stop loss" insurance in effect.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1104, effective July 15, 2010. -Created 1986 Ky. Acts ch. 437, sec. 16, effective July 15, 1986.
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